1)a man with penetrating chest trauma on left has now developed SOB his breathing has become

laboured no xray he has got tachypnoea n tachycardia. And there is also subcutaneous emphysema in neck ,on physical exam there is dull breath sounds plus mediastinum shift towards left side, whats the diagnosis? a- tension pneumothorax b- hemopneumothorax c- aortic dissection d- cardiac temponade e- aortic rupture

mediastinal shift towards lft indicates that it is tension pneumothorax on right side, both pneumothorax and hemothorax can cause decrease breath sounds but mediastinal shift is seen in tension pneumothorax.. immediate mx of this is needle insertion followed by tube thoracotomy
ANS:- B Tension pneumothorax but mediastinum shifts on opposite site..y towards?? HB pg.516

2) ECG of 70yr old womenvery bad one, just was able to appreciate ST elevation in lead II. options were a.pericarditis, b.anterolateral MI, c.PE, d.LBBB
PE:- S1Q3T3 +RBBB INFERIOR MI:- ST-elevation in leads 2,3,avF Anteriorolateral MI:diffuse st elevation in all leads plus low voltage ecg in pericarditis plus no Q waves ans absence of reciprocal leads differentiated it frm MI Rx of pericarditis is NSAIDs, aspirin or steroids

LBB:B: - William

3) A of female patient BMI 24 who had low LH , FSH, TSH 0.8, PROLACTIN high, she wanted to get pregnant, whats ur most appropriate management? a- clomiphene citrate b-IVF c-metformin d-Bromocriptine e- surgical resection of pituitary tumor

DDDDD..
TSH) blood test runs from approximately .5 to 4.5/5.0.
4)which is not true regarding pre-menopause stage? a-decrease in oestrogen b-increase in LH c-decrease in FSH sorry forgot 2options but they were irrelevant

CCCC..
Menopause
Menopause is the result of permanent loss of estrogen. Menopause occurs in patients aged 48 to 52. It starts with irregular menstrual bleeding. The oocytes produce less estrogen and progesterone, and both the LH and FSH start to rise. Women are symptomatic for an average of 12 months, but some women can experience symptoms for years. Symptoms Menstrual irregularity Sweats and hot flashes

 Mood changes Dyspareunia (pain during sexual intercourse) Physical Exam Findings Atrophic vaginitis Decrease in breast size Vaginal and cervical atrophy Diagnostic Tests/Treatment If the diagnosis is unclear, an increased FSH level is diagnostic. Hormone replacement therapy (HRT) is indicated for short-term symptomatic relief as well as the prevention of osteoporosis. Contraindications Estrogen-dependent carcinoma (breast or endometrial cancer) History of pulmonary embolism or DVT

5) A female patient whose mother died 3months ago & brother had died I think 6months back, she feels depressed , keep thinking about them , hear their voices. abcdeDepression with unresolved grief Schizophrenia Bipolar disorder Acute on chronic stress PTSD

AAAA..
6) A patient presented with vitals stable, ecg shows PVCs-no ECG given? Whats next appropriate treatment? a- metoprolol b- amiodarone

c-DC cardioversion d- reassurance e-verapamil

DDD
7) A 54y woman presented with a month of thick discharge from her left nipple. Dx: a. b. c. d. e. Benign duct papilloma Intraductal carcinoma in situ Mammary duct ectasia Paget disease Intraductal Carcinoma

CCCCC..
Bloodstained: - intraduct papilloma (commonest) - intraduct carcinoma - mammary dysplasia Green-grey: - mammary dysplasia - mammary duct ectasia Yellow: - mammary dysplasia - intraduct carcinoma (serous) - breast abscess (pus)

 Milky white (galactorrhoea): - lactation cysts - lactation - hyperprolactinaemia - drugs (e.g. chlorpromazine)

mammary duct ectasia

The larger breast ducts are dilated. The lump is usually located near the margin of the areola and is a firm or hard, tender, poorly defined swelling. There may be a toothpaste-like nipple discharge.

8) A patient comes in because of difficulty breathing. He reports that he is a very heavy drinker, and on physical exam there are basal crepitations on both lungs, with no cardiac murmurs and no shift of the apex beat. What is the most likely cause? a. MI b. Alcoholic cardiomyopathy c. Pulmonary embolism d. Pneumonia e.calcified aotic stenosis

if x ray is given and shows cardiomegaly then a otherwise I think its atypical pneumonia
Murmur only if involvement of papillary muscle..or mitral valve in DCM theres usually a murmur of MR, there should have been shifted apex beat ideally usually alcoholic is DCM

9) . The mother of one of your patients calls you, inquiring about the reason for her daughters consult. The daughter is 18 years old. What do you tell her? a. Tell her that you cannot disclose a patients information b. Tell her the reason for her daughters consult c. Tell her to come in tomorrow with her daughter d. Tell her to ask her daughter e. Tell her to make another appointment for her concerns

AAAAAAA.
10) A pt of walderstorms macrogobinuria with myelofibrosis presented with pic of scattered rash (vesicles) all over the abdomen of pt , history of ampicillin from 6 d in hospital, past H/O chicken pox in childhood,Diagnosis? a. Delayed hypersensitivity of ampicillin b. varicella zoster c.scabies d. UTI

BBBBBB.. The clinical manifestations of Waldenstrm

macroglobulinemia result from the presence of the IgM paraprotein and malignant lymphoplasmacytic cell infiltration of the bone marrow and other tissue sites. The clinical presentation is similar to that of multiple myeloma except that (1) organomegaly is common in Waldenstrm macroglobulinemia and is uncommon in multiple myeloma and (2) lytic bony disease and renal disease are uncommon in Waldenstrm macroglobulinemia but are common in multiple myeloma. (See Pathophysiology, Presentation, and Workup.) Complications Complications of Waldenstrm macroglobulinemia include the following: Hyperviscosity syndrome Visual disturbances secondary to hyperviscosity syndrome Diarrhea and malabsorption secondary to gastrointestinal (GI) involvement Renal disease (less common) Amyloidosis of the heart, kidney, liver, lungs, and joints Bleeding manifestations secondary to platelet dysfunction and coagulation factor and fibrinogen abnormalities due to interaction with plasma IgM Raynaud phenomenon secondary to cryoglobulinemia Increased predisposition to infection due to B-cell dysfunction (disease related) or T-cell dysfunction (therapy related, particularly after nucleoside analogues) Cardiac failure Increased incidence of lymphomas, myelodysplasia, and leukemias
if it is vesicular i think VZV and also as the pt is immunocompromised it may be the reactivation of the virus....if morbiliform then A

Waldenstrom's macroglobulinaemia is a malignant disease of B cells which are

lymphoplasmacytoid in appearance. These cells secrete IgM paraprotein which gives rise to clinical manifestations.

The disease is commonly seen in elderly men. It is an indolent disease with a median survival of 3 to 5 years, but some patients may survive 10 years or longer. It is regarded as a low grade non-Hodgkin's lymphoma.

the clinical picture varies widely according to the degree of tumour cell infiltration and the effects of IgM.

Commonly encountered features may include: peak incidence at age 60 - 70 years; slight preponderance for males usually present with fatigue related to anaemia serum hyperviscosity - causing mucosal and gastrointestinal bleeding, and retinal haemorrhage; due to engorged vessels and platelet dysfunction purpura hepatosplenomegaly and lymphadenopathy (rare in multiple myeloma) bone involvement is rare neurologic symptoms - alterations in consciousness, peripheral neuropathy, visual disturbance nausea and vertigo
The hallmark of Waldenstrom's macroglobulinaemia is the presence of a monoclonal IgM spike on serum protein electrophoresis in the beta or gamma globulin region.

Other features: increased serum viscosity anaemia - usually normochromic, normocytic; occasionally haemolytic raised ESR marked rouleaux formation; +ve Coomb's test bone marrow sections - hypercellular; infiltrated by the plasmacytic lymphocytes which are also present on peripheral blood Bence Jones proteinuria in at least 10% of cases x-rays should be normal; renal failure is unusual

IgM may cause cryoglobulinaemia

Supportive care - blood transfusions and antibiotics for infections.

Plasmaphoresis - for patients who present with severe hyperviscosity, e.g. retinal haemorrhage, intractable congestive failure; helps to reduce paraprotein levels. It may be sufficient to treat chronic disease. Intermittent chemotherapy with chlorambucil or cyclophosphamide, for chronic disease or acute disease which does not respond to plasmaphoresis.

11) U want to study effect of aspirin on osteoarthritis. Which study is most effective? a. Cohort study b. Cross-sectional study c. Case study d. Case control e. RCT

EEEEE.
A randomised controlled trial is a study in which there are two groups - anintervention group and a control group. Patients are randomly allocated to eachgroup. The intervention group then receives a treatment or test and the controlgroup receives no treatment or test. Randomised controlled trials are the standardmethod for answering questions about the effectiveness of different interventions Hb q no3.386

12) A 28weeks pregnant lady comes to ur practice with presenting complaint of a gush of clear fluid. On Speculum examination, PROM confirmed with closed cervix. In addition to transfer to tertiary care, what is the most appropriate management? a. Bethamethasone

b. Nifedipine c. Salbutmol d.CTG e. urgent USG

AAAA
13) A 26weeks pregnant lady who just flew back from England presented with C/O pain and swelling of her legs. Whats the most appropriate management of this patient? a. Warfarin b. Aspirin c.Non-fractioned heparin d.Compression stockings e. elevation of limbs

CCCCCc
Thromboembolism in pregnancy Pregnancy is associated with an increased risk of thromboembolism with an incidence of about r% of deep venous thrombosis (DVT). Untreated DVT carries about 15% risk of pulmonary embolism. DVT or pulmonary embolism should be suspected in a woman in the antenatal or postpartum period who complains of pain or swelling in the leg, mild unexplained fever, dyspnoea or chest pain. Risk factors include past history ofD VT, prolonged bed rest, operative delivery, multiparity, postpa1tum surgical procedure, anaemia, inherited thrombophilia disorders or anti phospholipid antibodies. If a DVT is suspected, low molecular weight heparin is recommended until investigation and specialist advice are obtained. The anticoagulant of choice is LMWH, which does not cross the placenta (warfarin does cross the placenta and is contraindicated in pregnancy) and isn't associated with osteopenia (unfractionated heparin causes osteopenia). - Warfarin is contraindicated, as it causes fetal abnormalities and even death.

14) A 35years old man was brought to ED after being received circumferential burns on his both legs in a camp fire. On examination ,his tibial pulses are feebily palpable. He had 15 cans of beers before sleeping, there is soot in his respiratory tractwhats the most appropriate management of this pt? a- I/V fluid blous b-sulphadiazine cream c-check serum level of alcohol d.-dressings of both legs e- fasciotomy

AAAA..
15) A hospital volunteer was bitten by a know HBsAg carrier patient and presented to u with 2*2cm of contaminated wound with clear teeth marks. Whats the most apporiate management? a-check Hbs Antigens of volunteer b- check Hbs Antibodies of volunteer c- give oral zidovudine to victim d- give Immunoglobulins and vaccine to victim e-check HIV status of victim
ANS:- B Jm pg.1353 if volunteer is immune-> no need to worry abt anything, if he's not indent immugonoglobin within 48 hrs

16) Q no 3.054 of handbooksame to same but no diagram

17) a man who was admitted in your hospital yesterday with complaint of pain abdomen and vomiting, now on second day he becomes jittery and restless . he started shouting and two security guards are controlling him. which of the following drugs will help in controlling his anger outburst ? a) b) c) d) oral olanzapine iv diazepam iv thiamine im haloperidol

BBBBB..
Alcohol withdrawal..jm-1221 Delirium tremens DTs is a serious life-threatening withdrawal state. It has a high mortality rate if inadequately treated and hospitalisation is always necessary. Clinical features May be precipitated by intercurrent infection or trauma 1-5 days after withdrawal (usually 3-4 days) Disorientation, agitation Clouding of consciousness Marked tremor Visual hallucinations (e.g. spiders, pink elephants) Sweating, tachycardia, pyrexia - Signs of dehydration Treatment Hospitalisation Correct fluid and electrolyte imbalance with IV therapy

 Treat any systemic infection Thiamine (vitamin 81 100 mg I M or IV daily for 3-5 days, then thiamine 100 mg (o) daily Diazepam 5 mg by slow IV injection (over several minutes) every half hour until symptoms subside or diazepam 10-20 mg (o) every 2 hours (up to max. 100 mg daily) until symptoms subside This dose is usually required for 2-3 days, then should be gradually reduced till finished. If psychotic features (e.g. hallucinations and delusions) add haloperidol 1.5-5 mg (o) bd, titrated to clinical response Note: Chlorpromazine is not recommended because of its potential to lower seizure threshold.'4 Diazepam and haloperidol may worsen the symptoms of hepatic toxicity.

18) Ankle jerk is lost, where is the lesion? a- L5 b-S1 c- L4 D- l3 E-L2

BBBBB.
L4-knee jerk L2,3,4-quadriceps but predominantly L4 L5-foot drop S1-ankle jerk and weakness of plantar flexion of foot
19) pt presented with bp 90/60, HR was low 40bpm n ECG showing sinus bradycardia.. no other complaints were mentioned .. wht nxt to do? a- amiodarone b- holters monitoring c-atropine d- Pacemaker e-Echocardiography

CCCCCCC..
Sinus brady may be hypercalcaemia ANS:- C Atropine then pacing http://emedicine.medscape.com/article/760220-treatment#a1126

if below 60 we see stable or unstable if stable we observe if unstable -> atropine then transcutaneous pacing, then dopa n epinephrine, then transvenous pacing

20) A pic of an old man presented with a swelling in neck on lateral side,somewhat like this, intra-oral exam was normal,,whats next appropriate management?

abcde-

Intra-oral sialogram FNAC US abdomen CT of head and neck MRI of head and neck

BBBBB.
http://dentistryandmedicine.blogspot.in/2012_02_01_archive.html

Metastatic Carcinoma in the Lymph Nodes Metastatic Carcinoma in the Lymph Nodes Metastases of oral squamous-cell carcinoma are a relatively common phenomenon and mainly occur in the regional cervical lymph nodes, via the lymphatic vessels. It has been estimated that approximately 3050% of patients with oral carcinoma present at diagnosis with cervical metastases. The submandibular and jugular nodes are more frequently affected. Clinically, the

metastases are not tender, and are usually firm, fixed, and swelling. The metastatic deposits are usually lateral, and rarely bilateral. Differential diagnosis Submandibular sialadenitis, Hodgkin disease, leukemia, tuberculosis, syphilis, infectious mononucleosis. . It has been estimated that approximately 3050% of patients with oral carcinoma present at 21) A female presented with sudden onset of right knee joint pain & swelling while she was asleep, she presented to you next morning what will you do: abcdAspiration Local injection of steroid Simple analgesia Splint

AAAA.
Joint pain and swelling so r/o septic arthritis first.

22) a female comes to ur clinic for pap smear,during examination u noticed some bruises and injuries on chest and abdomen which she called as result of injuries happened coz of episode of slipping in bathroom. What is ur next most appropriate management? a. call the police b. write in ur documents about injuries but dont tell woman c. explore more about cause of these injuries d. suggest her that she may b a victim of domestic violence e. do nothing

cccc
http://www.health.wa.gov.au/publications/documents/gudielines_for_responding_to_family_and_dom estic_violence.pdf

23) A pt of epilepsy well controlled on anti-epileptics comes for OCPs, what would u prescribe her? a- Microgynon 30 b-Yasmin c- Microgynon 50 d-HRT e-Yaz

CCCCC
jm-935,936

24) Diabetic patient taking OHG, blood glucose was 7.6,what will you do next : abcdeRepeat blood glucose Increase metformin Decrease metforim Do nothing Check Hb A1c

EEEEE
25) An old man presented with left knee swelling and tenderness with fever.. abcdeGout Pseudogout Septic arthritis Rheumatoid arthritis Osteoarthritis

CCCCCCC.

26) A 20 yrs old female presented with left sided lower abdominal pain, LMP 3 weeks back. next best : abcdBhcg Tvs Usg abdomen CT scan

AAAAA..
most commonly occurs in the ampulla of the fallopian tube.
Intrauterine pregnancy is normally seen on the following: Vaginal sonogram at 5 weeks gestation when serum B-hCG > 1,500 miU Abdominal sonogram at 6 weeks gestation when B-hCG > 6,500 miU if b hcg is <6500 at 6 wks then repeat jm says < 6 weeks, do beta hcg quantitative,6-8 weeks, TVS, > 8 weeks : ABDOMINAL usg

You cannot rule out a normal intrauterine pregnancy when B-hCG is < 1,500 miU. The next step is to repeat B-hCG and repeat the sonogram when B-hCG is > 1,500 miU.

27) Depressed patient with insomnia, wht is best choice of drug for him: abcdeMitrazepine Amitryptalline Fluxetine Venalexine Diazepam

AAAA
28) Nurses of nursing home contacts you and ask for an emergency visit of a 74y old man who makes a relationship with a 75 y old woman. They make a noise and disturbing the other neighbours. Both of them mentally capable. What are you doing in this situation:

a. b. c. d. e.

Let their families know Send the man to other nursing home Psychological assessment of them Provide privacy for them Shift them both to the same room

DDDDD????
29) A 35y woman presented with clear discharge from breast.. In the examination there is no lump in the breast with passage of nipple bloody discharge is obviously detected. Dx:

a. b. c. d. e.

Benign duct papilloma Intraductal carcinoma in-situ Mammary duct ectasia Paget disease Galactorrhea

AAAAAAA.
30) a 32weeks pregnant lady presented with vomiting..on examination everything normal,whats the most appropriate drug for her vomiting? a- Chlorpromazine b-metochlopramide c-codein d-PCM e-aspirin

BBBBB.

31) Scenario of a patient with PTE with raised level of serum creatinine. The stem asked about the next appropriate investigation a) D-dimer b) CTPA c) V-Q scan

CCCCC.
according to vmpf notes........v-q scan for those who can't take ctpa -pregnancy -allergic to iodine ac renal failure here creat is raised so c is the answer 32)Lesion of trigeminal Nerve. Which action is effected? a- numbness of pharynx b- eye opening c- failure to open jaw while eating d. loss of smile e- loss of unilateral sweating

CCCCC..
http://www.ncbi.nlm.nih.gov/books/NBK384/table/A1894/?report=objectonly 33) a young lady wants to conceive, she is well controlled on phenytoin for the last 2years,whats ur next appropriate management? a-cease phenytoin,change to Na valporate b-cease phenytoin,change to Carbamazapine c-cease all anti-epiletics d-give high estrogen OCPS

e-do nothing

BBBBB
34) A 32weeks pregnant lady comes for antenatal visiton physical examination,fetal parts are not palpablesymphysio-fundal height is 25cm, 4weeks back, her symphysio-fundal height was 24cm..her blood group is O ve.whats the most probab le diagnosis? a- Macrosomia b-DM c-hydrops fetalis due to Rh-isoimmunization d-multiple pregnancy

CCCCC
Jm-1034

35) A pregnant of 37weeks gestation comes with complains of reduced fetal movements for the last 24hrs..CTG done it was normal and pt was sent home with reassuranceshe now comes again after 3days that she is not feeling any baby movements..whats the most appropriate next step? a-immediate CTG b-obstetric USG c- reassure that its normal at this gestation d-Amniotomy e-induction with prostaglandins

AAAA

36)A pic of man with gynaecomastia ..who was on many drugs,like every drug on earth :D, whats the cause of this condition??really confused and made a tukka as all options cause it a- spironolactone b-Digoxin c-cimetidine d-marijauna
ANS:- A

37)A somalian with painless hematuria no specific timings of hematuria,recent immigrant. what s the likely cause? a- schistosomiasis b-CA kidney c-UTI D-BPH

AAAAA
38) 8 yr old boy with wt on 90th percentile and hight on 50th .next step a-reassure that its normal b-dietary advice c-test blood sugar level d-family therapy e-refer to dietry clinic

DDDDD..
http://www.ncbi.nlm.nih.gov/pubmed/20650975 40)

40) same as given above, with H/O inguinoscrotal swelling and u cant get above the swellingcause of this condition? a- teratoma of testis b-leydig cell tumor c- CA of breast d-factitious disorder e-metastasis from testicular CA
ANS:- B Jm pg.1050 Cant get above the swelling means-> inguniscortal Get above the swelling-> scortal AS both can cause gynaecomastiabut teratomas are more common the leyding cell tumor..also AFP and beta HCG are not increased in leyding cell tumor. http://emedicine.medscape.com/article/437020-overview

41) A 67 years old female comes with complain of dyspareunia.. she is postmenopausal and not using HRT..H/O 3normal deliveries and endometriosis treated once at 25yrswhats the next appropriate management in this pt? a- use vaginal dilators b-use vaginal creams c-start HRT d-COCP
BBBB.

42) A 34year old man diagnosed with Chlamydia and gonorrhea.. apart from treating him,whats next appropriate management in this patient? a- contact tracing b-advice condoms use c- treat all his contacts with antibiotics d-inform legal authorities
ANS:- A JM pg. 1102 Most cases r asymptomatic hence value of screening Tx:- 1st line :- azithromycin or doxycycline for 7 days 2nd line :- Erythromycin for 7 days Trace sexual contacts of previous 6 months, and even if they r asymptomatic treat them in a same way.

43) A 54yr old man presented with choking coz a bone piece from a beef steak, has difficulty in breathing. Whats next management? a-oral airway insertion b- Hemlichs manuveur c-oxygen by mask d-ETT e-cricothyroidotomy

BBBBB

44) A 52 year old man comes to ur office after watching a Tv program about melanoma screeningno family H/O, no Past history of any skin diseaseonly OLIVE MAN was mentioned in stemwhat should u advice him about screening? a-no screening is needed for him b-screening after every 3months c-screening after every 6months d-screening after every 2years e-screening after every 5years

ANS:- A GP CARD:Method and frequency of screening

Regular whole body visual examination of the skin by a medical practitioner, or by self has been suggested but there is no conclusive evidence that such examinations are effective in reducing mortality.

Who should be screened?

There is no conclusive evidence that screening of average risk people decreases mortality from melanoma. There is low grade evidence that individuals at high risk of melanoma could benefit from education to recognize and document lesions suspicious of melanoma, and to be regularly checked by a clinician with six-monthly full body examination supported by total body photography and dermoscopy as required. High risk individuals are not well defined but may include combinations of the following factors: age and sex; history of previous melanoma or non-melanoma skin cancer; family history of melanoma, including age of onset and multiplicity of any melanoma cases; the number of common melanocytic naevi; number of clinically atypical naevi; skin and hair pigmentation type and response to sun exposure; and evidence of actinic skin damage. Individuals with known inherited mutations in the genes encoded by the CDKN2A locus, p16INK4A and p14ARF have an increased melanoma risk, especially in the context of a family history of melanoma. Screening for a mutation in the CDKN2A gene be contemplated only after a thorough clinical risk assessment by a specialist genetic or melanoma clinic.

Red book pg.60

45) An alcoholic man was presented for rehabilitation after 2failed attemptswhats important question to ask? a-How much u drink per day? b-Have u ever been annoyed by people criticizing about ur drinking c-do u know safe level of alcohol? d-have u ever tried driving after being over-drunk?

BBBBB
http://www.patient.co.uk/doctor/cage-questionnaire
Cut down on your drinking Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?

46) An old man presented with delirium tremens, what next important step to do apart from initial resuscitation and thiamin?

abcde-

Diazepam Haloperidol Olanzapine Clozapine Procholarpromazine

ANS:- A 47) A 9years old child present with signs and symptoms of asthmawhats the most important test? a- Peak expiratory flow rate b- spirometry c-RFTs d-LFTs e-S/E
ANS:- B over 6y can be done......

48) an old man with COPD scenario, hypoxemic whats most imp thing to do? a- salbutamol b-Oxygen home therapy c-ipratropium bromide d-oral corticosteroids e-inhaled corticosteroids

BBBBBBB..
depends whether it is ac or chronic....... i cant make it out from this stem that whether it is ac or chr presentation............ but it looks like they are asking for ch....so b here if spo2<88%

Chronic Medical Therapy of COPD Tiotropium or ipratropium inhaler Albuterol inhaler Pneumococcal vaccine: Heptavalent vaccine, Pneumovax Influenza vaccine: Yearly Smoking cessation Long-term home oxygen if the p02 < 55 or the oxygen saturation is < 88 percent
Give home O2 :- < 7.3Pa = give home 02 If Po2 is = 7.3pa 8 Pa (with corpulmonale, Pulmonary HTN )

49) A 25years old man had his 2nd attack of epilepsy after having well controlled for 2years, for how long he should not drive? a- 3months b- 6months c- 2years d-never drive e-surrender his license
AAAAAA. Seizure free periods,

Uncontrolled + chronic = 2 years

Recently diagnosed epilepsy. Seizure-free period of 6 months from start of therapy (or 3 months on the recommendation of an experienced consultant). Chronic epilepsy (history of previously uncontrolled seizures). Generally a seizure free period of 2 years Recurrent Seizure. If a person on a conditional licence, who has previously been well controlled, has a recurrence of a seizure due to an identifiable and non-recurring provocation such as illness,

drug interaction or sleep deprivation, they should not drive for 1 month. If the cause is not identified the patient should not drive for3 months

50)following pic but with a lot of multiple lesions on a 10 year old girl eyelid, Diagnosis? a-warts b-skin tags c-neurofibromatosis d-lipoma e-SCC

BBBBBB
http://www.google.co.in/search?hl=en&bih=643&biw=1366&tbs=simg:CAESXRpbCxCo1NgEGgQIAggFD AsQsIynCBoyCjAIARIKjAWKBawErQSLBRog9osFZ2iyxJqUPHvUj8d4pld2bc8JpdDtnHV3m8iJtfYMCxCOrv4I GgoKCAgBEgTRDoivDA&q=skin+tag+on+eyelid&tbm=isch&sa=X&ei=obvFUYHuC8qxrAeNqIGACw&ved=0 CDwQsw4

51) a male presented with hypertension grade 3past history of well controlled HTN on low salt diet and multiple drug therapyafter some rest BP readings normal, whats the cause?

a- low salt diet b-drug compliance c-forgot the rest of options

white coat HTN??

52) An elderly pt with multiple drug therapy for HTN and diabetesnow presented with orthostatic hypotensionwhich drug is the cause? a- ACEI b- beta blockers c-Prazosin d-Ca channel blockers e-diuretics ANS:- C JM pg. 1278 Parazosin is 1st line therapy in DM, asthma, hyperlipidemia Prozosin :- orthostatic htn Acei:- 1st dose htn Other drugs causing postural hypotension are:Levodopa, phenothiazines, TCA, Jm pg.60 53) another one with multiple HTN drugs sorry forgot that questionread well antihypertensive therapy

54) A kid with symptoms of dka. blood sugar was 7.6mmole.what to investigate next

a-blood gas analysis b-hb A1c c-S/C d-other blood tests

AAAA..
Assessment of children and adolescents with DKA
1. Degree Of Dehydration (often over-estimated) None/Mild (< 4%): no clinical signs Moderate (4-7%): easily detectable dehydration eg. reduced skin turgor, poor capillary return Severe(>7%): poor perfusion, rapid pulse, reduced blood pressure i.e. shock 2. Level of consciousness - Glasgow Coma Scale 3. Investigations Venous blood sample (place an i.v. line if possible as this will be needed if DKA is confirmed) for the following: FBE Blood glucose, urea, electrolytes (sodium, potassium, calcium, magnesium, phosphate) Blood ketones (bedside test) Venous blood gas (including bicarbonate) Investigations for precipitating cause: if clinical signs of infection consider septic work up including blood culture For all newly diagnosed patients: Insulin antibodies, GAD antibodies, coeliac screen (total IgA, anti-gliadin Ab, tissue transglutaminase Ab) and thyroid function tests (TSH and FT4 Urine Ketones, culture (if clinical evidence of infection)

55) in a diabetic patient, what should be not be done 2yearly?

a- BP check b- diabetic retinopathy c- diabetic nephropathy D- foot care f- urine examination

ANS:- A BP + BMI + urine => 3 monthly Fundoscopy + foot care => yearly Review HbA1c atleast every 6-monthly Review lipid levels atleast every 12-monthly Jm pg.1298

dm guidelines for gp

56) A 39months child developmental mile stones..what should be expected from child at this age? a- speak in full proper sentences (27 months) b-ride bicycle c-kick a ball (24 months) d-can dress on his own (60 months) e-can draw a face (Around three to four years of age, children beginto combine the circle with one or more lines in order to represent a human figure. These figures typically start out looking like tadpoles or head-feet symbols )

BBBBB?
jm -845

57) A 6month old child presented by his mother as his grandmother though he should now be started be weaninghe is fully breast and on 50th percentile for wt and height. What should u advice mother? a- continue breast milk with apple juice b-continue breast milk with rice cereal c-start bottle feeding d-start weaning with semi-solid foods f- stop breast feeding and switch on to fomula milk

BBBBBBjm-848
Solids should be gradually introduced at about s-6 months, one at a time. Food should never be forced but introduced slowly. Solids should be offered after a feed or between feeds of milk. Breast milk or formula remains the most important food. Examples of solid foods for beginners are: -baby rice cereal mixed with their usual milk or cooled boiled water (best first option) cooked pumpkin, potato or carrot fruits such as banana, cooked apple or pear The texture should be pureed (no lumps). Introduce a new food only after 3-4 days, early in the day, and check for any allergic reaction. Start with r-2 teaspoons of solids and build up to three meals a day at your baby's own pace. Lumpy foods can be introduced at 6-9 months, as by this time babies learn to chew. By 9-ro months more solids should be eaten each mealtime and the milk gradually decreased. Cooled boiled water should be introduced as it is better than fruit juices. From 12 months onwards cow's milk can be introduced and more solid foods, especially meats, vegetables and fruits. Note: Babies on a cow's milk diet who eat little are prone to iron deficiency anaemia.

58) An 18 month old female baby presented with to u with enlarged breastshaving breast development at tanner stage 3,no pubic hairswhat is the most probable diagnosis?

a-congenital adrenarche b-gynaecomastia c-precocius puberty d-premature theralache e-delayed puberty

DDDD..jm-857
Premature thelarche This is the isolated breast development in girls under 8 years old. It occurs in girls under 2 years and spontaneous regression can be expected. It may present at birth. Observation with reassurance for this benign condition is appropriate. Premature adrenarche This is the isolated appearance of pubic hair (usually in a girl) under 8 years old. There are no other features of virilisation or oestrogenisation. It is usually a normal variant (no specific treatment available) but may signifY atypical congenital adrenal hyperplasia. Referral is indicated if any concerns.

59) A 4months child present as her mother noticed a mass in her neck while giving a bathno other associated complaints, what should be done? a- excision of mass b-FNAC c-reassurance d-USG of neck e-CXR

DDDDD.??

60) A foster mom of 2yr old child presented to uthe child is shy and dont want speak and dont want to go to kindergarten, mother gave history of violence to her by her various partners, as she is a prostitute by profession. Whats ur diagnosis regarding child? a- oppositional deficit b-dyslexia c-ADHD d-her behaviour is related to experience of violence e-touretts syndrome

DDDDD.
61) A 5yr old kid presented with his father after battery ingestion 2hrs ago, on CXR battery down the oesophaguswhats ur management? a-removed laproscopically b- remove immediately via endoscopy c-gastroscopy d-milk ingestion e-US abdomen
ANS:- B http://www.poison.org/battery/guideline.asp

Button and disc battery ingestion jm-911

If not in stomach these (especially lithium batteries) create an emergency if in the oesophagus because electrical current generated destroys mucous membranes and perforates within 6 hours (must be removed endoscopically ASAP). This also applies to the ear canal and nares.

Management for other FB Manage conservatively. X-ray all children (mouth to anus, especially chest and abdomen) on presentation (the oesophagus is a concern). Investigate unusual gagging, coughing and retching with X-rays of the head, neck, thorax and abdomen (check nasopharynx and respiratory tract Watch for passage of the FB in stool (usually 3 days). Defecate into a container. If not passed, order X-ray in 1 week. If a blunt FB has been stationary for 1 month without symptoms, remove at laparotomy.

http://emedicine.medscape.com/article/774838-treatment

62)one question on pyloric stenosis.which test? a-barium swallow b-USG c-Abdominal CT

BBBBBBB..

String sign is seen on upper Gl series (barium is swallowed and its passage is watched under fluoroscopy) can be seen in hypertrophic pyloric stenosis. Where -as string sign of cantor is seen in ulcerative collitis Doughnut sign is seen during intussusceptions. Bird's beak is seen in achalasia, steeple sign is seen during croup

63) one abdominal X-ray of small bowel obstructiontypical step ladder appearance, diagnosis asked?

64) An old women presented with joint stiffness in MCP and MTP joints, associated with morning stiffness which relieved by activity..whats the appropriate management? a-corticosteroids b-indomethacin c-Allopurinol d-colchicine e-splinting and rest

BBBB..
MTB STEP-3 118
65) a case of ITPdiagnosis was asked

66)A couple with fathers carrier of tuberous sclerosis while mother normal, what is the chance of their children effected with the disease? a- one in 2 effected, two normal b-one in 2 carrier, two normal c- all affected d-all carrier e-one in 4 carrier

ANS:- A

autosomal dominant 1 parent affect so------ 2 will b diseased and 2 will be normal. No carrier

67) HB question 3.083 68) PTE case asking for most appropriate test?

Gold standard is ct angio

69) Abdominal CTsomething like this but a very bad one,diagnosis? (40-year-old man with acute right lower
quadrant pain. Axial CT scan shows fat (asterisks) and soft-tissue mass (M) within loop of right colon with thickened wall ( open arrows ). Fat stranding ( solid arrows ) is noted surrounding this loop of bowel. Surgery confirmed colocolic intussusception with bowel ischemia and found that lead point was Burkitt lymphoma.)

a-small bowel obstruction b-LBO c-intussussception d-adhesion e-CA colon ANS:- C

http://www.medscape.com/viewarticle/501990_11

70) regarding rectal CA,what is true? a- anemina,dyspepsia,mass b- mass, bleeding, tenesmus c- obstruction, bleeding, altered bowel habits e- pain, obstruction, altered bowel habits ans:- B

71) A child with long cough history plus FTTwhats next investigation? a- CXR b-serology c-sputum culture d-US abdomen
ANS:- A? CF

72) A 16yr old college student presented with acute gastroenteritis, she also do part time job in food chain ..next to advice? a-wash hands frequently b-wear gloves while handling food c-give antibiotics to all his family d-advice her to leave her job e-full bed rest
ANS:- A During an outbreak, regular promotion of hand washing is recommended. In order for people to wash their hands during an outbreak they must have access to water, handwash (preferably liquid, not cakes of soap) or alcohol-based hand rubs or gels and disposable paper towels or single cloth towel. Where possible, institutions need to have access to PPE and staff need to be trained in how and when to use them http://www.health.gov.au/internet/main/publishing.nsf/content/F2A4C351C705B6C6CA257783000C24 CA/$File/norovirus-guidelines.pdf

73) a schizophrenic pt given flupenthixol decanoate for long time, side effect? a- tardive dystonia b-tardive dyskinesia c-akathisia d-neuroleptic syndrome

BBBBBBBB.
Flupentixol (INN), also known as flupenthixol (former BAN), marketed under brand names such as Depixol and Fluanxol, is a typical antipsychotic drug of the thioxanthene class

The side effects of flupentixol are similar to most other typical antipsychotics, namely extrapyramidal symptoms of akathisia, muscle tremors, and rigidity and antihistamine effects like sedation and somnolence. However, it lacks anticholinergic adverse effects.

ro-facial (tardive) dyskinesia, occurring in patients on long-term antipsychotic (dopamine antagonist) medication, can be suppressed temperarily by increasing the drug dose. Lowering the dose can exacerbate the condition. In patients receiving regular fluphenazine decanoate (FPZ) and flupenthixol decanoate (FPT) injections, characteristic profiles of the fluctuations in plasma level concentrations, occurring during the injection interval, have been demonstrated. The possible effects of these relatively predictable plasma level changes on the severity of oro-facial dyskinesia, and parkinsonism, were investigated. Regular assessment of oro-facial dyskinesia throughout the injection interval was carried out in six patients receiving FPZ and two patients receiving FPT. In both groups, changes were observed in the severity of oro-facial dyskinesia consistent with the expected effects of drug level fluctuations. The main implication of this finding is that, in investigations of tardive dyskinesia in patients receiving depot medication, ratings should be carried out at a standard time relative to injections.

74) again scenario of a psychotic pt, presented with involuntary twitching of face, mouth and tongue..diagnosis? a-akathisia b- dystonia c-facial n palsy d-tardive dyskinesia e-acute dystonia

DDDDDDD
Tardive dyskinesia
Tardive dyskinesia is a syndrome of abnormal involuntary movements of the face, mouth, tongue, trunk and limbs. This is a major problem with the use of long-term antipsychotic drugs and may occur months or years (usually) after starting treatment and with drug withdrawal. Differential diagnosis: spontaneous orofacial dyskinesia senile dyskinesia

 il l-fitting dentures neurological disorders causing tremor and chorea There is no specific treatment for tardive dyskinesia. The risks and benefits of continuing therapy have to be weighed. Note: Because of the inability to manage tardive dyskinesia, prevention in the form of using the lowest possible dosage of antipsychotic medication is essential. This involves regular review and adjustment if necessary.

75)A pt with presented with abdominal bloating, nausea, sense of fullness etcwhats the management? a- PPI b- domperidone c- antibiotics d-steroids e-H2 receptor blockers

BBBBBBB.
Prokinetic

Dx:- Gastopresis

76) A child presented with severe ear-ache,on examination TM is bulging and redwhat is true? a- myringotomy will get quick relief from pain b- antibiotic Drops are indicated c-nasal decongestants should be given d-oral antibiotics should be given

DDDDD.
Otitis Media
Key features include the following: Redness Bulging Decreased hearing Loss of light reflex Immobility of the tympanic membrane Although all of the findings above can be present, the most sensitive is the presence of immobility of the tympanic membrane. If the tympanic membrane is freely mobile on insuffiations of the ear, then otitis media is not present. The physical exam may also describe the absence of the light reflex. Diagnostic Testing There is no radiologic test to confirm the diagnosis, which is based entirely on physical examination. Patients may complain of decreased or muffled hearing. Treatment Best initial therapy: Amoxicillin. Usual course is 7-10 days; longer for younger patients and shorter for older patients. Next step: Perform the most accurate test, tympanocentesis and aspirate of the tympanic membrane for culture. This is rarely necessary and is only done for recurrent or persistent cases that fail therapy.

77) A case of unilateral headache in an old manwhat is the diagnostic test? a- FBC b-ESR c-CT scan d-MRI e-skull X-ray

ANS:- B Temporal arteritis.pan can soon become blind so do asap

78) A scenario of cholestatic jaundiceinvestigation asked? a- USG b-ERCP c-CT d-Sserum amylase e-troponins

A..jm-616
The investigations of choice for cholestatic jaundice are ultrasound and ERCP.
BEST diagnostic and therapeutic

79) Sub-Capital Femoral Epiphysis in 10yrs old sports boy 80) Osgood schlatter disease scenario..typical question

81)urge incontinence scenarioasking for management? a-Bladder re-education b-antocholinergics c-ring pessary d-bladder neck surgery

ANS:- A jm-815 it is urge incontinence yes

urge symptoms prominent no residual urine Treatment neurological signs~ neurologist abnormal voiding pattern ~bladder retraining (e.g. void more urine less frequently)

82) An old man presented with difficulty in reading esp in bright lights but can read easily inside..whats the diagnosis? a- Glaucoma b-Cataract c-retinal detachment d-refractive errors e-CRVO
ANS:- B

83)a smoker trying to quite smoking..what can u do to help him? a- nicotine gum patch b-inhaler c- reassurance and support d-CBT

AAAAAAa.

depends on how much he smokes..

84) A vegetarian lady and Lab values given with low hemoglobin, low MCVrest of FBC normalwhat investigation u will do for diagnosis? a- serum ferritin b- serum vit B12 c- serum folate level

AAAA here its veg but also mcv is low so its not megaloblastic anemia.. it may be iron defi so se ferritin here
85) Thyroid swelling picwhat symptom make u think of urgent surgical treatment? a- retrosternal extension b-hoarseness c- dysphagia d-dyspepsia e-puffiness of face on raising her arms above shoulders

BBBBBBB. Solved on fb
86) A pt after MVA blood on meatusindwelling catheter attempt failed twice, what next to do?

a- suprapubic aspiration b-suprapubic catheterization c-no choice of MCU

BBBBBBB..
87) A new CT picno hemorrhage, no infaction, no tumor just ventricles enlarged..diagnosis was asked? hydrocephalus

88) another CT of like this,diagnosis?

Ich..
89) A another old lady 4 hours post mi is very agitated. repeatedly getting out of bed and pulling away her iv lines? What to do? Sorry forgot options Hypoxia-> abgs

90) A lady with fever and post cervical tender lymph adenopathy. she has no of pet cats. Cause? a- toxoplasmosis b- ebv c- HIV d-cat scratch disease

ANS:- A
http://en.wikipedia.org/wiki/Toxoplasmosis#cite_note-11

91) Male patient came to you and told you that he feels like a he is a female trapped in male body from his childhood And he enjoys wearing women clothes and wearing makeup. Whats this condition called? a- Trans-sexualism b- Transversitism c- Poor self esteem d-Schizoid personality e- Schizophrenia

ANS:- A
Transvestic fetishism Over a period of 6 months, heterosexual male patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.

The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Typically, patients derive sexual gratification from wearing clothes usually worn by the opposite sex, and patients typically are heterosexual married males (not a DSM-IV-TR criterion).

Transsexualism describes the condition in which an individual identifies with a gender inconsistent or not culturally associated with their assigned sex, i.e. in which a person's assigned sex at birth conflicts with their psychological gender. A medical diagnosis can be made if a person experiences discomfort as a result of a desire to be a member of the opposite sex,[1] or if a person experiences impaired functioning or distress as a result of that gender identification.[2] Transsexualism is stigmatized in many parts of the world but has become more widely known in Western culture in the mid to late 20th century, concurrently with the sexual revolution and the development of sex reassignment surgery (SRS). Discrimination or negative attitudes towards transsexualism often accompany certain religious beliefs or cultural values.

In trans sexualism pt has the desire for oppsite sex.

http://emedicine.medscape.com/article/293890-overview#aw2aab6b4

92) A 50 year old man comes for Ca colon screening as his FOBT comes positiveno signs and symptoms and no family history of CA..what next to do? a- sigmoidoscopy b- Repeat FOBT c-barium meal d-CT scan

AAAAAA
If FOBT is positive-investigate by colonoscopy or by flexible sigmoidoscopy.(jm-431)

93) A female schizophrenic pt gets attracted to uand invites u on a coffee date, u are also attracted to her..what should be ur next step? a- decline her request and treat her b- accept her request and continue treating her c-accept her request and stop treating her d-decline her request and refer her to another doctor e-just go for coffee and nothing more than that

DDDDD
94) 68 yo menopaused lady on HRT for 5 years. She stopped them 2 months ago due to a publicity about breast CA. now hot flushes came more severe than before. MX? Resume COCP O or P pills alone Testosterone Danzen Mirena
ANS:- A

95) Patient normal in all aspect for routine exam except for a thick erythematous subcutaneous line on medial aspect of the thigh. MX a-Bed rest and elevation b- Low molecular weight Heparin c-Antibiotics d-Surgical intervention e-Compression stockings

DDDDDDDDDDDD(jm-705) If the problem is above the knee, ligation of the vein at the saphenofemoral junction is indicated. Next mx:- A Best:- D

96) Patient with multiple lower limb fracture. After 3 day post op he has right sided pleuritic chest pain and shortness of breath, x-ray show bilateral interstitial infiltrate . What is your diagnosis? a. Bronchopnuemonia b. Fat embolism c. Pulmonary embolism d. Atelectasis e-UTI ans:- B

Chest radiography of Fat embolism :- Serial radiographs reveal increasing diffuse bilateral pulmonary infiltrates within 24-48 hours of onset of clinical findings.

http://emedicine.medscape.com/article/460524-workup#a0720

97) A pt presented with acute cholecystitis 2nd episode in 2yrshe had MI treated one month, on isotope scan 3weeks back.. non functioning gall bladder, what would u do? a- do immediate cholecystectomy b-do immediate laproscopy c-immediate laprotomy d-give some time to settle down then do cholecystectomy e-postponed operation for 3months pt ans:- D/B?

98) you are invited to have a speech for parents of primary school children of age 610years ,what topic will u choose to speak about? A. pap smear B. alcohol C. weight reduction

D. diabetes symptoms E. physical exercises for fitness ANS:- E

99) U r an intern who knows that ur supervisor registrar is abusing alchol.. what should u do? a-confront ur registrar b-inform hospital management c-report medical board d-its his personal matter,do nothing ANS:- B

100) A smoker has calf muscle pain after walking for 200 meter, what is the next investigation u will do in this patient? a. Angiography b. Duplex Doppler USG c. CT d. MRI e. venogram ANS:- B wrong ya habibi ans is a 101) Toddler presents with shortness of breath and wheezing. Her ronchi disappear after salbutamol. Both parents smoke and the mother got hay fever. Apart from treating the child, what would you prescribe for the child. a. Salbutamol b. Steroid c. Ipratropium bromide d. acromolyn ANS:- A wrong ya habibi ans is d 102) Parents come to your practice with their 10 months old baby with high fever and bulging anterior fontanellae. The baby has high fever, neck stiffness and one episode of seizure.

a. Brain abscess b. Acute meningitis c. Trauma d. epilepsy e- septicemia ANS:- B

103)one question of breast cancer decrease riskobesity 104) CT brain like thisDx, signs and symptoms of neck stiffness present, some dark black colour around ventricles..again made a tukka :P

a-closed trauma hydrocephalus b-cryptosporidium Meningitis c- bacterial meningitis d-TB e-ICH ANS:- A??

Thats all I could remember..keep me in ur prayers!!!

Fluph decanoate: